Question: October 2016

A 49 -year-old man, who is under the care of the nephrology clinic as he has CKD due to autosomal dominant polycystic kidney disease admitted to the nephrology ward being unwell. He has a 3 day history of left loin pain, mild nausea, and fever. On physical examination, the patient looks ill. Temperature is 39 °C , blood pressure is 130/85 mm Hg, pulse rate is 110 bpm, and respiratory rate is 22/min. Chest is clear and heart sounds are normal. Abdomen is soft but with left costovertebral angle tenderness and bowel sounds are audible.

Laboratory results :

HB 135 g/l

WCC 15,000 X109 /l

S. creatinine 2.1 mg/dl (186 mmol/l)

Urine Dipstick Negative

Negative urine culture.

Ultrasound KUB : the left kidney is 16.7 cm, and the right kidney is 16.9 cm; multiple bilateral intraparenchymal cysts are noted consistent with polycystic disease.